Gastroesophgeal Reflux Dissease In Elderly:esophageal Manometry And 24-hour PH Monitoring

Objective:(1 )To study the differences of esophageal motility in healthy elderly and young healthy sujects. (2)To investigate esophageal motility and esophageal acid exposure in elderly and non-elderly patients with gastroesophageal reflux disease (GERD). (3)To investigate effect of sliding hiatal hernia on esophageal manometry and pH-metry in GERD.Methods : Elderly control group(n= 16) and non-elderly control group(n==18) had no esophageal disease history and GER symptoms~ no abdominal surgery and peptic ulcer history. Elderly patients(n=46) and non-elderly patients(w=23) had typical GER symptoms such as heartburn or acid regurgitation.. 33 elderly patients and 1.2 non-elderly patients with esophagitis on endoscopy, 30 elderly patients and 10 non-elderly patients with sliding hiatal hernia(HH) on upper gastrointestianl series. Antacids and prokinetic agents were discontinued for 3 days prior to the study. Esophageal manometry and 24-hour pH monitoring were performed by a four-lumen catheter hydrocapillary perfusion system (PC Polygraf HR, Sweden) and a portable digital pH recorder (Digitrapper MX III, CTD-SYNECTICS,Sweden).Results:1. In healthy elderly group~ the lower esophageal sphincter pressure (LESP), the pressure of distal esophageal contraction and the percentage of peristaltic contraction were lower than those in young controls, and the total percent of reflux time, the total number of reflux episodes, the number of reflux episodes lasting for more than 5 mm and the duration of longest reflux episode had no difference as compared to young controls. 2. Elderly and non-elderly patients with esophagitis showed a lower LESP as compared to corresponding controls. The percentage of peristaltic contraction did not differ significantly between elderly patients with GERD and elderly controls.Non-elderly patients with GERD, especially with esophagitis, showed a lower percentage of peristaltic contraction as compared to non-elderly controls. Elderly and non-elderly patients, especially with esophagitis, showed a lower pressure of contraction at the distal esophagus as compared to corresponding controls, and the pressure was lower significantly4q**U3t~in elderly patients than in non-elderly patients. Elderly patients with GERD showed a higher extent of reflux (the total percent of reflux time, the percent of reflux time in the upright position, the percent of reflux time in the supine position, the total number of reflux episodes~ the number of reflux episodes lasting for more than 5 mm and the duration of longest reflux episode ) as compared to non-elderly patients with GERD. The subgroup of elderly patients with esophagitis had a higher number of reflux episodes lasting for more than 5 mm than the subgroup of elderly patients without esophagitis. And the subgroup of non-elderly patients with esophagitis had a higher total percent of reflux time than the subgroup of non-elderly patients without esophagitis. 3. Elderly patients with GERD and HH showed a lower LESP compared with elderly GERD patients without HR and elderly controls. Non-elderly patients with GERD and H1H also showed a lower LESP compared with non-elderly controls, though LESP did not differ significantly between non-elderly GERD patients with HR and non-elderly GERD patients without HR. Elderly GERD patients with HH showed a lower pressure of contraction at the distal esophagus compared with elderly GERD patients without HR. Extent of reflux (the total percent of reflux time, the total number of reflux episodes, the number of reflux episodes lasting for more than 5 mm and the duration of longest reflux episode ) had no difference between elderly GERD patients with HR and elderly GERD patients without HH~ nor did it between non-elderly GERD patients with HR and non-elderly GERD patients without HR.Conclusions:1. The elderly had the impaired functions of esophagus antireflux and the reduced peristaltic activity of the esophagus. 2. The functions of esophagus antireflux and the peristaltic activity of...